In a radical departure from New York City's longstanding practice of ensuring healthcare access by subsidizing the hospital-based safety net, a mayoral task force has recommended directly financing indigent care through expanded insurance coverage.
Led by Maria K. Mitchell, the mayor's health policy adviser and chairwoman of New York City Health and Hospitals Corp., the panel proposed creating a capitated insurance program financed primarily through $900 million in taxes on providers and insurers. The proposal follows a previous report in which the task force recommended privatizing certain HHC hospitals and eventually dissolving the city's public healthcare system (See related story, p. 24).
Covering low-income, uninsured residents through private managed-care plans is expected to cost about $1.5 billion annually. Some $900 million of that would be generated through a 2% tax on healthcare providers and a 2% tax on insurance premiums.
The rest would come from anticipated Medicaid savings and a diversion of funds from the state's bad debt and charity-care pools. However, since the commission's work began eight months ago, the state has proposed cutting Medicaid expenditures and dismantling its hospital rate-setting system. The panel acknowledged that its financing proposal may need to be altered to account for such "changes and uncertainties" in healthcare.
"We're very supportive of the recommendation to expand insurance to the uninsured," said Kenneth E. Raske, president of the Greater New York Hospital Association. However, the association hasn't determined how much such a program would cost hospitals.
But community health advocates said the blueprint lacks reliable financial assumptions as well as details on how the city's frailest and sickest would be served under a private system.
"Unfortunately, I think we still have no viable plan as far as the practical reality of uninsured New Yorkers," said Lani Sanjek, a member of the coordinating committee of the Commission on the Public's Health System.